Advertisement

Disparities in Preventable Hospitalizations Among Public Housing Developments

Published:December 13, 2018DOI:https://doi.org/10.1016/j.amepre.2018.08.019

      Introduction

      This study assesses preventable hospitalization rates among New York City residents living in public housing developments compared with all New York City residents and residents in low-income areas. Additionally, preventable hospitalization rates by development (one or multiple buildings in close proximity and served by the same management office) were determined.

      Methods

      The 2010–2014 New York City hospital discharge data were geocoded and linked with New York City Housing Authority records using building-level identifiers. Preventable hospitalizations resulting from ambulatory care–sensitive conditions were identified for public housing residents, citywide, and residents of low-income areas. Age-adjusted overall and ambulatory care–sensitive, condition–specific preventable hospitalization rates (11 outcomes) were determined and compared across groups to assess potential disparities. Additionally, rates were ranked and compared among public housing developments by quartiles. The analysis was conducted in 2016 and 2017.

      Results

      The age-adjusted rate of preventable hospitalization was significantly higher among public housing residents than citywide (rate ratio [RR]=2.67, 95% CI=2.65, 2.69), with the greatest disparities in hospitalizations related to diabetes (RR=3.12, 95% CI=3.07, 3.18) and asthma (RR=4.14, 95% CI=4.07, 4.21). The preventable hospitalization rate was also higher among residents of public housing than low-income areas (RR=1.33, 95% CI=1.31, 1.35). There were large differences between developments ranked in the top and bottom quartiles of preventable hospitalization (RR=1.81, 95% CI=1.76, 1.85) with the largest difference related to chronic obstructive pulmonary disease (RR=3.38, 95% CI=3.08, 3.70).

      Conclusions

      Preventable hospitalization rates are high among public housing residents, and vary significantly by development and condition. By providing geographically granular information, geocoded hospital discharge data can serve as a valuable tool for health assessment and engagement of the healthcare sector and other stakeholders in interventions that address health inequities.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

      1. Agency for Healthcare Research and Quality. Prevention Quality Indicators Overview. www.qualityindicators.ahrq.gov/modules/pqi_resources.aspx. Accessed March 6, 2017.

      2. Agency for Healthcare Research and Quality. Potentially Avoidable Hospitalizations.www.ahrq.gov/research/findings/nhqrdr/chartbooks/carecoordination/measure3.html. Content last reviewed July 2016. Accessed March 1, 2018.

        • Biello KB
        • Rawlings J
        • Carroll-Scott A
        • Browne R
        • Ickovics JR
        Racial disparities in age at preventable hospitalization among U.S. adults.
        Am J Prev Med. 2010; 38: 54-60
        • Billings J
        • Zeitel L
        • Lukomnik J
        • Carey TS
        • Blank AE
        • Newman L
        Impact of socioeconomic status on hospital use in New York City.
        Health Aff (Millwood). 1993; 12: 162-173
        • Feng C
        • Paasche-Orlow MK
        • Kressin NR
        • et al.
        Disparities in potentially preventable hospitalizations: near-national estimates for Hispanics.
        Health Serv Res. 2018; 53: 1349-1372
        • O'Neil SS
        • Lake T
        • Merrill A
        • Wilson A
        • Mann DA
        • Bartnyska LM
        Racial disparities in hospitalizations for ambulatory care-sensitive conditions.
        Am J Prev Med. 2010; 38: 381-388
        • Pappas G
        • Hadden WC
        • Kozak LJ
        • Fisher GF
        Potentially avoidable hospitalizations: inequalities in rates between U.S. socioeconomic groups.
        Am J Public Health. 1997; 87: 811-816
      3. U.S. Department of Housing and Urban Development. Picture of Subsidized Households. www.huduser.gov/portal/datasets/assthsg.html. Accessed May 9, 2018.

        • Althoff KN
        • Karpati A
        • Hero J
        • Matte TD
        Secular changes in mortality disparities in New York City: a reexamination.
        J Urban Health. 2009; 86: 729-744
        • Dawson P
        • Perri BR
        • Ahuja SD
        High tuberculosis strain diversity among New York City public housing residents.
        Am J Public Health. 2016; 106: 563-568
        • Lewis CE
        • Raczynski JM
        • Heath GW
        • Levinson R
        • Cutter GR
        Physical activity of public housing residents in Birmingham, Alabama.
        Am J Public Health. 1993; 83: 1016-1020
        • Peters JL
        • Levy JI
        • Rogers CA
        • Burge HA
        • Spengler JD
        Determinants of allergen concentrations in apartments of asthmatic children living in public housing.
        J Urban Health. 2007; 84: 185-197
        • Digenis-Bury EC
        • Brooks DR
        • Chen L
        • Ostrem M
        • Horsburgh CR
        Use of a population-based survey to describe the health of Boston public housing residents.
        Am J Public Health. 2008; 98: 85-91
      4. Helms VE, Sperling J, Steffen BL. A Health Picture of HUD-Assisted Adults, 2006–2012: HUD Administrative Data Linked With the National Health Interview Survey. U.S. Department of Housing and Urban Development. www.huduser.gov/portal/sites/default/files/pdf/Health-Picture-of-HUD.pdf. Published March 2017. Accessed November 13, 2018.

      5. New York City Housing Authority. Special Tabulation of Resident Characteristics. www1.nyc.gov/assets/nycha/downloads/pdf/res_data.pdf. Published January 1, 2015. Accessed March 6, 2017.

      6. U.S. Census Bureau. 2010–2014 American Community Survey 5-Year Estimates. American Fact Finder website. https://factfinder.census.gov. Accessed February 14, 2018.

      7. New York State Department of Health. Statewide Planning and Research Cooperative System (SPARCS). www.health.ny.gov/statistics/sparcs. Accessed June 26, 2017.

      8. New York City Housing Authority. NYCHA Property Directory Development Guide. www1.nyc.gov/assets/nycha/downloads/pdf/Development-Guide-05102016.pdf. Published May 10, 2016. Accessed March 6, 2017.

      9. New York City Department of City Planning (DCP). Geosupport Desktop Edition. BYTES of the BIG APPLE™. Version 17a. NYC Open Data. www1.nyc.gov/site/planning/data-maps/open-data/dwn-gde-home.page. Accessed February 28, 2017.

      10. GM Culp. rGBAT16AB: GeoSupport for R. R package. Version 16.2. https://github.com/gmculp/rGBAT16AB. Published 2016. Accessed February 13, 2017.

      11. U.S. Census Bureau. American Community Survey and Puerto Rico Community Survey. 2014 Subject Definitions. www2.census.gov/programs-surveys/acs/tech_docs/subject_definitions/2014_ACSSubjectDefinitions.pdf. Accessed March 6, 2017.

      12. NYC Department of Health and Mental Hygiene population estimates, modified from U.S. Census Bureau interpolated intercensal population estimates, 2000–2015. Updated August 2016.

        • Keyfitz N
        3. Sampling variance of standardized mortality rates.
        Hum Biol. 1966; 38: 309-317
        • Rothman KJ
        • Greenland S
        • Lash TL
        Modern Epidemiology.
        Lippincott Williams & Wilkins, Philadelphia, PA2008
        • Tsao TY
        • Konty KJ
        • Van Wye G
        • et al.
        Estimating potential reductions in premature mortality in New York City from raising the minimum wage to $15.
        Am J Public Health. 2016; 106: 1036-1041
      13. Parton HB, Greene R, Flatley AM, et al. Health of Older Adults in New York City Public Housing: Findings from the New York City Housing Authority Senior Survey. A joint report by the New York City Housing Authority, the New York City Departments of Health and Mental Hygiene and for the Aging, and the City University of New York School of Public Health at Hunter College. www1.nyc.gov/assets/nycha/downloads/pdf/senior-report-nycha.pdf. Published May 2011. Accessed November 13, 2018.

        • Adamkiewicz G
        • Spengler JD
        • Harley AE
        • et al.
        Environmental conditions in low-income urban housing: clustering and associations with self-reported health.
        Am J Public Health. 2014; 104: 1650-1656
      14. Kheirbek I, Wheeler K, Walters S, Pezeshki G, Kass D, Matte T. Air pollution and the health of New Yorkers: the impact of fine particles and ozone. A report by the New York City Departments of Health and Mental Hygiene. www1.nyc.gov/assets/doh/downloads/pdf/eode/eode-air-quality-impact.pdf. Accessed November 16, 2017.

        • Helms VE
        • King BA
        • Ashley PJ
        Cigarette smoking and adverse health outcomes among adults receiving federal housing assistance.
        Prev Med. 2017; 99: 171-177
      15. New York City Department of Health and Mental Hygiene. Epiquery: NYC Interactive Health Data System. Community Health Survey 2015. http://nyc.gov/health/epiquery. Accessed May 17, 2017.

        • Lopez PM
        • Islam N
        • Feinberg A
        • et al.
        A place-based community health worker program: feasibility and early outcomes, New York City, 2015.
        Am J Prev Med. 2017; 52: S284-S289
        • Kass D
        • McKelvey W
        • Carlton E
        • et al.
        Effectiveness of an integrated pest management intervention in controlling cockroaches, mice, and allergens in New York City public housing.
        Environ Health Perspect. 2009; 117: 1219-1225
        • Berwick DM
        • Nolan TW
        • Whittington J
        The triple aim: care, health, and cost.
        Health Aff (Millwood). 2008; 27: 759-769
        • Anuta J
        How many people live in the city's public housing? The answer is in the trash.
        Crain's New York Business. October 29, 2015; (Accessed May 7, 2018)